The Crowne Plaza Hotel, Cleveland - Wednesday 3 - Friday 5 November 2010

Event Registration

To ensure that we account for all your requirements please complete all relevant parts of the form.
Please note that a separate registration form must be completed for each attendee.

If you have any queries about your booking please contact us,
1451 Quail Street, Suite 104. Newport Beach, CA 92660-2747. Tel: (949) 757-1877 | Fax: (949) 757-1877,
Email: conferences@downsedusa.org

Attendee Details
Title:	e.g. Mr/Mrs/Miss/Dr
* First Name:
* Last Name:
Job Title:
Organization:
Correspondence Address – This will be used for all future correspondence
* Address 1:
Address 2:
* City:
State:
* Zipcode:
Country:
Contact Details – Please include all area codes
* Tel No:
* Fax No:
* Email:
Invoice Address - Once you submit your booking form payment options will be displayed. Please note payment by credit card is the preferred method and confirms your booking immediately. We are pleased to supply an invoice to those non-profit organizations or schools that require it.
Contact Name:
Organization:
Address 1:
Address 2:
City:
State:
Zipcode:
Country:
Purchase Order Number (if applicable):
Email address:
Delegate Package - Please select the relevant delegate type below:
2 day In-Depth Track: (Wednesday / Thursday)	$420
1 day Essentials Track: (Friday)	$210
Please choose at least one delegate package from above
Workshop options
2 day In-Depth Track Wednesday / Thursday:	Please Select Early years in depth (0-5 years) Elementary years in depth (5-11 years) Speech and Language in depth
1 day Essentials Track Friday:	Please Select Early years essentials (0-5 years) Elementary years essentials (5-11 years) High school years essentials (11-16 years)
Dietary Requirements – If you have any special requirements with regard to your diet, please tick below. Please be very specific.
	Vegetarian
	Vegan
Other: (e.g. nut or wheat allergy / kosher / Halal) PLEASE BE VERY SPECIFIC	None
Personal Requirements
Please indicate any other personal requirements.	None
Accommodation Requirements - if you would like accommodation at the Crowne Plaza Hotel, Cleveland South - Independence (formerly the Skyline Independence) - please contact the hotel direct on 216-524-0700 and ask for reservations. Quote reference "Downsed" to obtain the special conference accommodation rate. Alternatively you can book online using the code "DUS" http://go.downsed.org/?cleveland2010hotel
Booking Terms and Conditions
Please click here for full Terms and Conditions. I confirm that I have read the registration terms and conditions and wish to continue with this booking.   *
Please complete all fields marked above as "Required".